Panic Disorder and other Anxiety Disorders

Panic Disorder is apart of a larger class of psychological disorders known as Anxiety Disorders. Subjects with panic disorder have what are known as panic attacks which can occur at any time for any number of reasons. During panic attacks subjects will have labored breathing, heart palpitations, chest pain, intense apprehension, and fear of losing control. There are medical and psychological ways of treating this disorder. The psychotherapy way of treating Panic Disorder is known as Panic Control Treatment. Panic Control Treatment can be split up into five main sections or steps. These sections include educate and inform subject with regard to symptoms, exposing the subject to interoceptive sensations that remind them of panic attacks, cognitive-behavioral therapy, deep muscle relaxation, and assigning homework.

The first step in Panic Control Treatment is to educate and inform with regard to the symptoms. You start this by diffusing the danger and reassuring the subject that his symptoms do not have fatal consequences. Start with the heart rate, subject having panic attacks experience heart rates of up to 200 beats per min. Assure the patient they are not having a heart attack and the human heart can beat that way for days. Second is suffocation. Your brain has reflex mechanisms to make you breath. If a person feels like they are going to faint it is due to rapid breathing high in their chest with leads to a decrease of oxygen in the body causing hyperventilation. The effects of any change in the level of carbon dioxide include your heart pumping harder and faster, increased constriction of blood vessels in brain (feeling of dizziness & disorientation), and increased alkalinity of nerve cells, (more jittery & excitable). When this occurs the subject should breathe from their diaphragm and/or use the vasa vegal reflex which involves putting palms together in front of chest to prevent fainting. Another technique is to breathe into a paper bag to prevent hyperventilation. The weakness the body is experiencing is due to dilated blood vessels and high levels of adrenaline. Dilated blood vessels keep the blood from circulating in a functional fashion.

The second step is to expose the subject to clusters of interoceptive sensations that remind them of panic attacks. They do this by having the subject perform various tasks to create the sensations. This can include spinning in a chair to invoke nausea and dizziness, hyperventilating to cause tingling, disorientation, and shortness of breath. The therapeutic effects were proved by Carter in ’95. He found that safe places make a person less likely to panic therefore the sensations do not as a matter of course lead to panic.

Cognitive-Behavioral Therapy is the third step or section. Cognitive-Behavioral Therapy starts with the basic attitudes and perceptions concerning the dangerousness of the feared situation. This starts with identifying the danger. Subjects are expected to keep a diary of cognitions and interoceptive sensations. The diary is to be put into the form of situation, symptom security, and thoughts. For example a subject is sitting in his office and begins to choke, feel mildly dizzy, and increased heart rate. Consequently the person begins thinking “Oh I can’t have a heart attack here! People will see me and I might get fired. I’m suffocating and I’m going to faint.” Next we try to explore external stimuli as a trigger. The office in this situation could have been stuffy and/or warm which caused these feelings of suffocations. Another possibility is that the subject was under a lot of stress and had negative or fearful thoughts before the symptoms occurred. Not all stimuli are in awareness therefore some probing or exploring of possibilities is necessary. Lastly decatasrophize the situation by using a disputation.

The fourth step is deep muscle relaxation including systematic desensitization and breaking retraining. This is effective for many different reasons. One of these reasons is that the response is incompatible with fear therefore replacing it with relaxation. Jocobson’s research conducted during the 30’s found that S.N.S. arousal is not possible when striated muscles are relaxed. It was reported that deep muscle relaxation had a direct correlation with blood pressure decrease and improvement of ulcer catilus. Wolpe’s ’58 was the first experiment to develop a method fro treating phobias with muscle relaxation. This allowed for gradual exposure to stimuli that the subject fears while maintaining control of symptoms. In order for this to happen the subject must be trained to relax all muscles in the body. After this the subject sets goals and clarifies vague complaints. The next step is to develop hierarchies. The subject will then act out these hierarchies gradually exposing them to the “supposedly” harmful stimuli. Apart of this step is the Anxiety Scale which is a common way of rating your current state of anxiety. The therapeutic effect of this is to reduce anxiety increases before cognitive and S.N.S. arousal are excessive.

The final step of Panic Control Treatment is to assign homework. A lot to the therapy and treatment for panic disorder will be conducted during everyday life. This homework includes relaxation training, and challenging catastrophic thoughts. Another part of the homework is to enact the actual tasks, such as using the hierarchies and coping statements. Coping statements are statement subject repeat to themselves based on actual experiences.

The National Institution of Mental Health conducted a study on Panic Control Therapy at four separate University research centers. The study original study was headed by Barlow in 1989 and the follow up also by Barlow in ’91. The 304 subjects in the study had a baseline of five panic attacks per week and were randomly assigned to four conditional groups. The study was carried out over 12 weeks.

The independent variable in the study was P.C.T. and drug treatment. The drugs used in the study were Tricyclic Antidepressants. Group 1 was given P.C.T. and the drugs. Group 2 was given P.C.T. and a placebo. Group 3 was given only P.C.T. Group four received only the drug. Groups 1, 2, and 4 all had the same results. 90% of the subjects in these groups were panic free at the end of the 12 weeks. Group 3 only saw 49% of subject become panic free at end of 12 weeks. Other studies like this one were done by Barlow and Clark ’94, Barlow ’97, and Clark ‘2001 with a 15 month follow up. At the two year follow up the subjects in Groups 1, 2, and 4 were all panic free while Group 3 got sick again. In conclusion the National Institution of Mental Health, Public Health Division issued a quote, “The psychological treatment should offered initially, followed by drug treatment, for those patients who do not respond adequately of for those who psychological treatment is not available!”

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